Pharmacy Owner Pleads Guilty in Connection with Health Insurance Fraud Scheme
McALLEN, Texas ‐ The 45-year-old owner of Penitas Family Pharmacy has pleaded guilty in connection with a scheme to defraud Blue Cross Blue Shield of Texas, announced Acting U.S. Attorney Abe Martinez. Omar Espericueta, of Palmhurst, pleaded guilty today, joining co-defendant Oscar Elizondo, 47, of Pharr, who pleaded guilty on Wednesday.
Both men conspired to submit more than $1.7 million in fraudulent claims through Penitas Family Pharmacy aka Riverside Pharmacy to Blue Cross Blue Shield of Texas for expensive pain patches and scar creams.
Espericueta employed marketers, such as Elizondo, to target employees of entities throughout the Rio Grande Valley with health insurance through Blue Cross and other private insurance carriers. The marketers solicited employees with meals, drinks and promises of “free” prescription pain patches and scar creams in order to obtain their health insurance information. The co-conspirators then used the insurance information, along with fraudulent prescriptions, to submit hundreds of fraudulent and medically unnecessary claims to Blue Cross. Other employees saw a doctor, but it was a doctor with whom Espericueta had made arrangements to sign fraudulent prescriptions. Espericueta admitted to providing the doctor with prescription pain medication as well as cash “loans” that the doctor never repaid.
Employees were never told that Espericueta’s Pharmacy planned to use their health insurance information to bill Blue Cross for several thousand dollars worth of prescriptions for each employee, many of whom stated they did not want or need the patches or creams. In many instances, Espericueta’s Pharmacy billed Blue Cross for prescriptions that were never delivered to employees, including multiple refills that were never requested.
Both men face up to 10 years in federal prison and a $250,000 maximum fine. Sentencing has been set for Feb. 7, 2018, before U.S. District Judge Randy Crane.
The FBI, Mission Police Department, Texas Department of Insurance – Fraud Unit and Texas Health and Human Services Commission conducted the investigation. Assistant U.S. Attorney Andrew Swartz is prosecuting the case.